Are hypochlorite acid products like CLn (chlorine) Wash or Skin Smart Eczema Spray effective for managing eczema?

Hypochlorous Acid Products for Eczema Management

Sodium hypochlorite body wash products like CLn Wash or Skin Smart Eczema Spray can be effective adjunctive treatments for managing eczema, particularly in patients with Staphylococcus aureus colonization. 1

Mechanism and Evidence

Hypochlorous acid products work primarily by:

• Reducing Staphylococcus aureus colonization, which is common in atopic dermatitis patients
• Providing anti-inflammatory effects beyond simple antimicrobial action
• Potentially offering a steroid-sparing effect when used as part of a comprehensive regimen

A prospective, open-label study found that daily use of 0.006% sodium hypochlorite body wash improved multiple outcome measures in moderate-to-severe S. aureus-colonized atopic dermatitis in children and adolescents 1. Notably, there was a 36.5% decrease in topical corticosteroid use by the end of the study compared to baseline.

Place in Treatment Algorithm

1. First-line therapy: Emollients and moisturizers remain the foundation of eczema treatment

   • Apply emollients 3-8 times daily, even when skin appears normal 2
   • Apply immediately after bathing to lock in moisture

2. Topical anti-inflammatory agents: When emollients alone are insufficient

   • Topical corticosteroids (applied once daily rather than twice daily) 2, 3
   • Topical calcineurin inhibitors for sensitive areas 2

3. Antimicrobial/antiseptic therapy: For patients with recurrent infections or S. aureus colonization

   • Sodium hypochlorite products (CLn Wash, Skin Smart Eczema Spray)
   • Bleach baths (0.005% sodium hypochlorite) twice weekly 4, 2

4. Advanced therapies: For severe, refractory cases

   • Phototherapy (narrowband UVB) 4, 2
   • Systemic agents (dupilumab, JAK inhibitors, etc.) 2

Practical Recommendations

• Concentration matters: Products with 0.006% sodium hypochlorite concentration have shown efficacy 1
• Frequency: Daily use is typically recommended
• Application: Apply to affected areas according to product instructions
• Combination therapy: Use alongside standard eczema treatments (emollients, topical anti-inflammatories)
• Patient preference: Studies indicate patients often prefer hypochlorite body washes over traditional bleach baths 1

Cautions and Limitations

• While hypochlorite products can reduce S. aureus colonization, one study found that 64% of patients still tested positive for S. aureus after 2 weeks of treatment 1
• Evidence suggests these products work through mechanisms beyond simple antimicrobial action 1, 5
• Studies on hypochlorite products have been relatively small with some methodological limitations 5
• These products should supplement, not replace, standard eczema treatments

What to Avoid

• Oral antihistamines have limited evidence for treating eczema symptoms 3
• Oral or topical antistaphylococcal treatments for infected eczema lack strong evidence 3
• Probiotics have not been shown to effectively treat established eczema 3
• Nonpharmacological treatments like silk clothing, ion-exchange water softeners, and emollient bath additives have not demonstrated significant benefits 3

Hypochlorous acid products represent a promising adjunctive therapy for eczema management, particularly for patients with recurrent infections or known S. aureus colonization, but should be used as part of a comprehensive treatment approach that includes proper moisturization and appropriate anti-inflammatory therapy.